9 Practice scenarios in ICD 10 cm and PCS for inpatient with rationale.

1.When a patient comes in with pain due to malignancy and the treatment is for the pain, would the pain code be sequenced first, followed by the malignancy code. 
Should a code for the site of the pain be assigned in addition to the malignancy code.

 

The appropriate PDx for this scenario is G89.3.

 

Rationale: When a patient presents with pain due to malignancy, the primary reason for the admission is the pain. Therefore, the pain code should be sequenced first. 
Additionally, a code for the site of the pain should be assigned in addition to the malignancy code to provide more specific information about the patient's condition.

 

2.Patient is admitted with CVA with left sided weakness. Tpa was not administered for the patient also the hospital progress notes were stating cerebral edema. 
Radiology reports documents midline shift with cerebral edema. Assign all the appropriate codes for the scenario and also if the query is necessary or not.

I63.9,G93.6,G81.94 and Query for radiological significance
I63.9,G93.6,G81.91
I63.9,G93.6,G81.94
None of the above

 

The appropriate codes for the scenario are I63.9 (Cerebral infarction, unspecified), G93.6 (Cerebral edema), and G81.94 (Hemiplegia, unspecified affecting left dominant side). A query for radiological significance may be necessary.
Rationale: The patient was admitted with a cerebral infarction (stroke) with left-sided weakness, and radiology reports document midline shift with cerebral edema.
The hospital progress notes also state cerebral edema. Therefore, appropriate codes for the scenario are I63.9 (Cerebral infarction, unspecified), G93.6 (Cerebral edema), 
and G81.94 (Hemiplegia, unspecified affecting left dominant side). A query for radiological significance may be necessary to clarify the significance of the midline shift.

 

3. If GI bleed is due to gastric varices and the patient have of cirrhosis of liver, is it appropriate to use Cirrhosis of liver as PDx.
True
False

 

False. It is not appropriate to use Cirrhosis of liver as PDx when a patient has GI bleed due to gastric varices.
Rationale: When a patient has GI bleed due to gastric varices, the primary reason for the admission is the GI bleed, not the cirrhosis of the liver. 
Therefore, cirrhosis of liver should not be used as the PDx.

 

4. Patient is admitted with low back pain. PMH have lumbar radiculopathy. Consulting physician documents pain pumps should be inserted during this admission since the
lower back pain is due the spinal dJD. Assign the appropriate PDx.

 

The appropriate PDx for the scenario is M47.26 (Other spondylosis with radiculopathy, lumbar region).
Rationale: The patient was admitted with low back pain, and the consulting physician documented that pain pumps should be inserted due to spinal DJD. 
The PMH also included lumbar radiculopathy, indicating that the low back pain is related to nerve root compression. 
Therefore, the appropriate PDx for this scenario is M47.26.

 

5. If during this admission the stage of the decubitus ulcer has progressed from Stage 3 to stage 4, what is the POA for stage 4.

 

Yes or No

 

No, there is no POA for stage 4 decubitus ulcers.
Rationale: POA (present on admission) is used to indicate whether a condition was present at the time of admission. Since the stage of the decubitus ulcer progressed from stage 3 to stage 4 during the admission, there is no POA for stage 4.

 

6.Patient is admitted with Bleeding esophageal varcies and underwent EGD with esophageal banding. Patient had ESRD, CHF, HTN, Portal hypertensive gastropathy.
Final diagnosis states- GI bleeding, Esophageal varices, gastritis. Assign Pdx for this scenario.

 

The appropriate PDx for this scenario is K76.6 (Portal hypertension).
Rationale: The patient was admitted with bleeding esophageal varices and underwent EGD with esophageal banding. The patient also had ESRD, CHF, HTN, and portal hypertensive gastropathy. The final diagnosis includes GI bleeding, esophageal varices, and gastritis. Therefore, the appropriate PDx for this scenario is K76.6.

 

7.The patient is a 48-year-old male with glioblastoma multiforme status post two surgeries. The tumor has recurred with massive growth since debulking one month ago. 
The provider indicated that there was a significant amount of surrounding vasogenic edema and mass effect. Is it appropriate to assign a code for cerebral edema when it 
is due to a primary intracranial process such as a brain tumor and the provider has indicated that it is clinically significant. True or False

 

True. It is appropriate to assign a code for cerebral edema when it is due to a primary intracranial process such as a brain tumor and the provider has indicated that it is clinically significant.

 

Rationale: If the provider has documented that cerebral edema is clinically significant and due to a primary intracranial process such as a brain tumor, it is appropriate to assign a code for cerebral edema.

 

8.What is the appropriate code for flat back syndrome of lumbar region.

 

The appropriate code for flat back syndrome of lumbar region is M40.36. This code is used to describe a specific type of spinal deformity that is characterized by a loss of lumbar lordosis.

 

9. Patient is admitted with adenocarcinoma of lung and is having severe neoplasm related pain. Patient underwent chemotherapy and also IV morphine for the pain management. Assign appropriate codes for the following PDX as well as SDx.

 

The appropriate PDX code for adenocarcinoma of lung is C34.90. The appropriate SDx code for severe neoplasm related pain is G89.3. These codes are used to describe the patient's primary condition and the associated pain respectively. The use of the G89.3 code helps to ensure that the severity of the patient's pain is properly captured and treated. The use of the chemotherapy and IV morphine is also documented in the medical record to provide a complete picture of the patient's treatment plan.